Electroencephalographic findings in antileucine-rich glioma-inactivated 1 (LGI1) autoimmune encephalitis: A systematic review

Roberto, Katrina T.; Espiritu, Adrian I.; Fernandez, Marc Laurence L.; Gutierrez, Josephine C.

doi:10.1016/j.yebeh.2020.107462

Cited by 17 publications

(11 citation statements)

References 38 publications

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“…Anti-NMDA encephalitis was the most commonly observed AE type, followed by LGI1 encephalitis. The gender distribution and the proportion of AE subtypes tended to be consistent with those of previous reports (1,15). In this study, the incidence of disease onset peaked in patients aged 11-20 and 61-70 years, a finding that differed from prior reports, which showed that peak incidence of disease onset occurred in young and middle aged patients (3,14).…”

Section: Discussionsupporting

confidence: 89%

Characteristics and Prognosis of Autoimmune Encephalitis in the East of China: A Multi-Center Study

Qiao

Liu

et al. 2021

Front. Neurol.

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Objective: This study aimed to investigate epidemiological characteristics, clinical manifestations, and long-term outcomes of patients with autoimmune encephalitis (AE) in the east of China.Methods: From January 2015 to December 2019, 226 potential AE patients were recruited from five clinical centers, and a total of 185 patients who met the diagnostic criteria were included in the study. We retrospectively reviewed clinical features, auxiliary examinations, details of treatments, and outcomes of AE, and identified risk factors of poor prognosis. Modified Rankin Scale scores were used to evaluate neurological function, and scores of 3–6 indicated a poor-prognosis.Results: Patients with five main subtypes of AE were enrolled in the study, as follows: anti-NMDAR (79), anti-LGI1 (55), anti-CASPR2 (30), anti-GABABR (16), and anti-AMPAR (5). Among 185 patients, 58.38% (108/185) were male and 41.62% (77/185) were female. The median age at disease onset was 41 years (interquartile range, 17–62). The most common clinical manifestations of AE were seizures (146, 78.92%) and memory deficit (123, 66.49%). A total of 95 (51.35%) patients had abnormal brain magnetic resonance imaging results. Electroencephalographic findings were abnormal in 131 (70.81%) patients, and 168 (90.81%) and 26 (14.05%) patients were treated with first- and second-line immunotherapies, respectively. All surviving patients were followed-up for at least 1 year (range 12–36 months). Good clinical outcomes were achieved in 117 (63.24%), while 68 (36.76%) patients had a poor prognosis. Further, 33 (17.84%) patients relapsed and 10 (5.41%) died within 1 year post-discharge. Older patients tended to have a poorer prognosis, and the occurrence of mental behavioral disorders, movement disorders, disturbance of consciousness, central hypoventilation, and tumors were overrepresented in the poor-prognosis group.Conclusions: AE is a treatable disease, and most patients have a good prognosis. There are differences in the clinical manifestations of patients with different AE subtypes. Some with AE will relapse, and long-term follow-up is of great significance for further research.

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Section: Discussionsupporting

confidence: 89%

Characteristics and Prognosis of Autoimmune Encephalitis in the East of China: A Multi-Center Study

Qiao

Liu

et al. 2021

Front. Neurol.

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“…Additionally, according to a meta-analysis ( 91 ), the detection sensitivity of PET in anti-LGI1 encephalitis was 87% (79–92%), I 2 of 0% ( p = 0.89), suggesting that PET, as a new medical technology, was of high value in diagnosis of anti-LGI1 encephalitis. As for EEG, epileptiform discharge and abnormal EEG with no epileptiform discharge were two key features, in line with another study ( 92 ).…”

Section: Discussionsupporting

confidence: 87%

Clinical Features and Therapeutic Effects of Anti-leucine-rich Glioma Inactivated 1 Encephalitis: A Systematic Review

Teng

Zeng

et al. 2022

Front. Neurol.

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Background: Clinical presentations and treatment programs about anti-leucine-rich glioma inactivated 1 (LGI1) encephalitis still remain incompletely understood.Objective: This study analyzed the clinical features and therapeutic effects of anti-LGI1 encephalitis.Methods: PubMed, EMBASE, and the Cochrane Library were searched to identify published English and Chinese articles until April 2021. Data were extracted, analyzed, and recorded in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines.Results: A total of 80 publications detailing 485 subjects matched our inclusion criteria. Short-term memory loss (75.22%), faciobrachial dystonic seizures (FBDS) (52.53%), other seizures excluding FBDS (68.48%), psychiatric symptoms (57.67%), and sleep disturbances (34.30%) were the most frequently described symptoms in anti-LGI1 encephalitis. Hyponatremia (54.90%) was the most common hematologic examination change. The risk of incidence rate of malignant tumors was higher than in healthy people. The positive rate of anti-LGI1 in serum (99.79%) was higher than CSF (77.38%). Steroids (93.02%), IVIG (87.50%), and combined use (96.67%) all had a high remission rate in the initial visit. A total of 35 of 215 cases relapsed, of which 6/35 (17.14%) did not use first-line treatment, and 21 (60.00%) did not maintain long-term treatment. Plasma exchange (PE) could be combined in severe patients, immunosuppressant could be used for refractory patients or for recurrence and using an anti-epileptic drug to control seizures may benefit cognition.Conclusions: Short-term memory loss, FBDS, psychiatric symptoms, and hyponatremia were key features in identifying anti-LGI1 encephalitis. Serum and CSF antibody tests should be considered in diagnosis criteria. Steroids with IVIG should be recommended, PE was combined for use in severe patients, immunosuppressant therapy might improve outcomes if recurrence or progression occurred, and control seizures might benefit cognition. The useful ways to reduce relapse rate were early identification, clear diagnosis, rapid treatment, and maintaining long-term treatment. The follow-up advice was suggested according to the research of paraneoplastic syndrome, and concern about tumors was vital as well.

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“…In our study, 45.7% of the 70 par-ticipants were seizure free within 1 year after onset without relapse during the ongoing follow-up, and 68.6% of the 70 participants did not have seizures after a 2-year follow-up. These results are similar to the incidence of seizures of 47.5% reported by Roberto et al [9].…”

Section: Discussionsupporting

confidence: 92%

“…Increased slow waves were observed in 45.6% cases, and epileptiform discharges in 50.9% participants. These EEG findings were consistent with previous studies [9]. Participants with long-term seizures tended to have increased incidence of the following findings: abnormal EEG results, slow waves, and epileptiform discharges.…”

Section: Discussionsupporting

confidence: 92%

“…Seizures are manifested in more than 85% of participants with anti-LGI-1 encephalitis [5,7,8]. Of participants with seizures reviewed by Roberto et al, 47.5% were seizure free on follow-up, while 36.9% were reported to be improved, and 15.6% continued to have seizures on follow-up [9]. However, the duration of follow-up ranged diversely, from 1 week to 9 years.…”

Section: Introductionmentioning

confidence: 99%

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Long-term seizure outcomes in patients with anti-Leucine-rich glioma-inactivated 1 encephalitis

Lin¹,

Liu²,

Chen³

et al. 2021

Epilepsy & Behavior

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Background: This study aimed to investigate the semiology of seizure disorders, including electroencephalographic characteristics, and seizure outcomes in participants with anti-leucine-rich gliomainactivated 1 (LGI-1) encephalitis. Methods: Seventy participants who presented with seizures during the acute phase of anti-LGI-1 encephalitis at Peking Union Medical College Hospital from May 2013 to July 2020 were reviewed. All participants underwent follow-up for longer than 2 years. Results: At the time of presentation, 48 (68.6%) participants had generalized seizures and 57 (81.4%) had focal seizures. The most common focal motor seizures were faciobrachial dystonic seizures (FDS). The main manifestations of focal nonmotor seizures were dyscognitive features, goosebumps, and disorders of sensation. All participants received immunomodulatory therapy. Thirty-five (50%) participants were seizure free after 1 year of follow-up, and 48 (68.6%) participants were seizure free over a follow-up of 2 years. Participants with seizures continued longer than 1 year were older than participants whose seizure duration was shorter than 1 year (P = 0.021). However, after an extended follow-up period, the difference between the incidences of seizures based on age was not significant. The frequency of focal motor seizures was higher in participants who became seizure free within 1 year, compared to participants who had seizures for longer than 1 year (75% vs 54.3%, respectively; P = 0.015). Participants with seizures continued over 2 years tended to have focal nonmotor seizures, and tended to show an elevated incidence of abnormal EEG results. Participants receiving early corticosteroid and longer duration immunosuppressant treatments, tended to have a lower risk of persistent seizures and better seizure outcomes, with no statistical significance. Conclusions: Most participants obtained remission from seizures after immunomodulatory therapy. The seizure manifestation of anti-LGI1 encephalitis is diverse and variable. The type of focal seizures may affect the outcome of participants with seizures. Older age could lead to longer duration of the seizure disorder, but did not affect the rate of seizures over the long term. Early and prolonged administration of immunomodulatory therapy may be useful for shortening the time to becoming seizure free.

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Electroencephalographic findings in antileucine-rich glioma-inactivated 1 (LGI1) autoimmune encephalitis: A systematic review

Cited by 17 publications

References 38 publications

Characteristics and Prognosis of Autoimmune Encephalitis in the East of China: A Multi-Center Study

Characteristics and Prognosis of Autoimmune Encephalitis in the East of China: A Multi-Center Study

Clinical Features and Therapeutic Effects of Anti-leucine-rich Glioma Inactivated 1 Encephalitis: A Systematic Review

Long-term seizure outcomes in patients with anti-Leucine-rich glioma-inactivated 1 encephalitis

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